Daphne Fontenot
Individual provider Active NPI Pharmacist · Granite Falls, NC
NPI 1841601697 · NPPES record last updated Oct 14, 2024
Key facts
- NPI
- 1841601697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28432 (NC)
- Practice address
- 4780 Hickory Blvd
Granite Falls, NC 28630-8237 - Phone
- (225) 324-9558
- NPI assigned
- May 14, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15938 | LA | MD | Pharmacist |
| 28432 | NC | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15938 | LA | |
| Pharmacist | 183500000X | 28432 | NC | Yes |
Addresses
Primary practice location
4780 Hickory Blvd
Granite Falls, NC 28630-8237
Mailing address
11753 James Richard Dr
Charlotte, NC 28277-4031
Phone (225) 324-9558
NPI Registry JSON
{
"created_epoch": "1400025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728864000000",
"number": "1841601697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11753 JAMES RICHARD DR",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282774031",
"telephone_number": "225-324-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4780 HICKORY BLVD",
"city": "GRANITE FALLS",
"state": "NC",
"postal_code": "286308237",
"telephone_number": "225-324-9558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONTENOT",
"first_name": "DAPHNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-14",
"last_updated": "2024-10-14",
"certification_date": "2024-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "15938",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "28432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite Falls, NC
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- Edward J. Bujold MD
- Emergeortho, P.a.
- Brittany Erby
- Falls Pediatrics
- Foothills Physical Therapy
- Melody Foster
- Melanie Franklin
- Gaits of Hope, LLC
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All providers in Granite Falls, NC · Pharmacist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.